- Email: [email protected]
Do Pre- and Postnatal Growth Failure Increase the Severity of Bronchopulmonary Dysplasia or Pulmonary Hypertension in Preterm Infants?
SUNDAY, OCTOBER 22
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Dietary Supplement Use in a Southern College Student Population Author(s): K. Anguah1, E. Plasterer2, J. Pope1, D. Erickson1; 1Louisiana Tech University, 2Community Health Network Learning Outcome: Examine prevalence of dietary supplement use in a southern college student population. Background: About half of American adults report using dietary supplements; research on supplement use in college students is limited. The purpose of this study was to determine the prevalence and motivations of dietary supplement use in a southern college student population.
Disagreement between Registered Dietitian and Medical Provider in Identifying Malnutrition among Hospitalized Patients Author(s): S. Send, L. Klemp, S. Peterson, D. Sow; Rush University Medical Center Learning Outcome: To describe discrepancies between RD and provider interpretation of malnutrition.
Conclusion: The prevalence of dietary supplement use among this population (62%) is similar to findings from adult populations. Additional research is needed to determine motivation for dietary supplement use among college students.
Accurate identification and documentation of malnutrition is essential to ensure reimbursement and allocation of resources. A best practice alert (BPA) was created to alert providers via the electronic medical record for each patient the registered dietitian (RD) identified as malnourished. The purpose of this quality improvement project was to describe discrepancies between RD and provider interpretation of malnutrition. The RD completed a nutrition assessment on adult patients defined as “at nutritional risk” based upon institution guidelines. The RD documented malnutrition category (mild, moderate, severe). A BPA fired to communicate the malnutrition category to the provider until malnutrition was added to the problem list or dismissed (due to disagreement or not being the primary team). The total number of malnourished patients and provider dismissals due to disagreement with RD from April-December 2016 were collected. A total of 2522 patients were categorized as malnourished. Providers disagreed with the malnutrition diagnosis for 286 patients with 9% categorized as malnourished in error. Of the remaining patients, 47%, 41%, and 3% were classified as mild, moderate and severe malnutrition, respectively. Providers were more likely to dismiss the BPA for overweight/obese patients classified as mild malnutrition (64%, p<0.001). The frequency of dismissal increased over the time: 29% (AprilJune), 34% (July-September) and 37% (October-December). Eleven providers were responsible for approximately a quarter of all BPA dismissals. There is lack of agreement between the RD and medical provider’s classification of malnutrition, specifically among overweight/obese patients. Further training is required to educate providers to educate providers to identify malnutrition.
Funding Disclosure: None
Funding Disclosure: None
Differences in Respiratory Muscle Strength in Well-nourished versus Malnourished Hospitalized Patients
Do Pre- and Postnatal Growth Failure Increase the Severity of Bronchopulmonary Dysplasia or Pulmonary Hypertension in Preterm Infants?
Author(s): H. Zellner, O. Moss, S. Hicks-McGarry, E. Moran, E. Becker, S. Peterson, S. Foley; Rush University Medical Center
Author(s): L. Lamport, I. Gershkovich, M. Ahmed, B. Weinberger, R. Schanler; Cohen Children’s Medical Center of New York, Northwell Health System
Learning Outcome: To determine the differences in measures of respiratory muscle strength between hospitalized patients who are malnourished vs. normally nourished.
Learning Outcome: Many studies have demonstrated that preterm infants with pulmonary hypertension (PH) and bronchopulmonary dysplasia (BPD) have higher nutrient requirements in order to achieve long term growth. No human study has investigated how pre- and post natal growth failure impacts severity of BPD and/or PH among premature infants. The learning objective was to determine if growth failure (pre & postnatal) is associated with BPD and or PH severity among VLBW infants.
Methods: A Dietary Supplement Use Questionnaire, sent to students via email, was designed by the investigators to determine the demographics, prevalence, and motivation of dietary supplement use. The Chi-square test was used to analyze differences in prevalence of dietary supplement use based on gender, ethnicity, and motivation for use. Results: A total of 372 completed surveys were returned; eight were excluded due to incomplete data. Survey respondents were more likely to be Caucasian females between the ages of 19 and 21 years of age (n¼ 198, 54%), with a high school degree (n¼ 258, 71%). Almost two-thirds (62%) reported using dietary supplements. Multivitamins were the most commonly reported dietary supplement and increased energy was the most common benefit identified. Most respondents reported using only one dietary supplement regularly (43.7%) at a frequency of six to seven times per week (52.1%). There were no significant differences in dietary supplement use and motivation for use between males and females or between Caucasians and African Americans.
Objective measurement of muscle mass is an essential component of nutritional assessment. Subjective global assessment (SGA) and handgrip strength (HGS) are tools used to assess nutritional status and musculature; however both have limitations. Depletion of muscle mass can manifest in loss of respiratory muscle strength (RMS). The purpose of this study was to determine differences in RMS measures (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP)) in normally nourished vs. malnourished hospitalized patients using a crosssectional design. Nutritional status was assessed using SGA by a dietitian and MIP, MEP, and SNIP measures were obtained by a respiratory therapist. Independent t-tests were used to determine differences in RMS measures between subjects assessed as normally vs. malnourished per SGA. Of 140 patients who completed testing, 50% were normally nourished and 50% malnourished with mean age of 51.1 17.4 vs. 57.8 16.9 years, respectively (p ¼ 0.023). There was no significant difference in MIP between normally nourished (88.4 36.5%) and malnourished (77.6 36.0%, p¼0.093) subjects, and no significant difference in MEP (62.1 22.1 vs. 57.1 25.6%, p¼0.234). Malnourished patients had significantly lower values of SNIP (63.3 30.7%) compared to normally nourished patients (77.8 27.0%, p¼0.004). Use of RMS measures specifically SNIP, should be further investigated to assess nutriture and holds promise as a proxy measure of musculature. RMS measures may contribute to the arsenal of nutritional assessment measures used by dietitians. Funding Disclosure: Academy of Nutrition and Dietetics Foundation Grant, Dietitians in Nutrition Support Dietetics Practice Group
Background: Intrauterine growth restriction (IUGR) and postnatal growth failure (PNGF) are common in premature infants. Bronchopulmonary dysplasia (BPD) is chronic lung disease of prematurity, which can be associated with pulmonary hypertension (PH). The objective was to determine whether IUGR and PNGF increase the severity of BPD and PH. Methods: Infants with birth weight <1500 g and need for supplemental oxygen at 1 mo were enrolled prospectively (n¼68). Anthropometric measures were recorded at birth, 1 mo and 36 wks postmenstrual age (PMA), z-scores determined based on Fenton curves. PNGF was defined as weight < 10th percentile or z-score < -1.3. At 36 wks PMA, BPD severity was determined by NICHD criteria, and PH was quantified by echocardiography. Results: IUGR was present in 5 infants (7%), and PNGF in 17 (25%) at 1 mo and 24 (37%) at 36 wks PMA. There were no significant correlations between z-scores for weight, or intrapatient changes in z-score over time, and the severity of BPD or PH. Similarly, IUGR, PNGF, and nutrition were not predictive of BPD or PH. Mean daily intakes were 110.3 and 132.0 kcal/kg, and 3.9 and 4.2 g/kg protein at 1 month and 36 wks PMA. Of note, within-patient changes in growth z-score from 1 month to 36 wks were negatively correlated with changes in caloric intake, indicating that infants with the largest weight losses received the largest increases in calories.
Conclusion: The incidence of PNGF increases between 1 mo and 36 wks PMA in premature infants, but pre- and postnatal growth are not predictive for the severity of BPD or PH. PNGF increased despite achieving optimal targets for energy and protein intake. It is possible that the potential adverse effects of PNGF on pulmonary function are masked by improved nutrition. Funding Disclosure: Cohen Children’s Medical Center of New York, Northwell Health
A-22
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
September 2017 Suppl 1—Abstracts Volume 117 Number 9
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Dietary Supplement Use in a Southern College Student Population Author(s): K. Anguah1, E. Plasterer2, J. Pope1, D. Erickson1; 1Louisiana Tech University, 2Community Health Network Learning Outcome: Examine prevalence of dietary supplement use in a southern college student population. Background: About half of American adults report using dietary supplements; research on supplement use in college students is limited. The purpose of this study was to determine the prevalence and motivations of dietary supplement use in a southern college student population.
Disagreement between Registered Dietitian and Medical Provider in Identifying Malnutrition among Hospitalized Patients Author(s): S. Send, L. Klemp, S. Peterson, D. Sow; Rush University Medical Center Learning Outcome: To describe discrepancies between RD and provider interpretation of malnutrition.
Conclusion: The prevalence of dietary supplement use among this population (62%) is similar to findings from adult populations. Additional research is needed to determine motivation for dietary supplement use among college students.
Accurate identification and documentation of malnutrition is essential to ensure reimbursement and allocation of resources. A best practice alert (BPA) was created to alert providers via the electronic medical record for each patient the registered dietitian (RD) identified as malnourished. The purpose of this quality improvement project was to describe discrepancies between RD and provider interpretation of malnutrition. The RD completed a nutrition assessment on adult patients defined as “at nutritional risk” based upon institution guidelines. The RD documented malnutrition category (mild, moderate, severe). A BPA fired to communicate the malnutrition category to the provider until malnutrition was added to the problem list or dismissed (due to disagreement or not being the primary team). The total number of malnourished patients and provider dismissals due to disagreement with RD from April-December 2016 were collected. A total of 2522 patients were categorized as malnourished. Providers disagreed with the malnutrition diagnosis for 286 patients with 9% categorized as malnourished in error. Of the remaining patients, 47%, 41%, and 3% were classified as mild, moderate and severe malnutrition, respectively. Providers were more likely to dismiss the BPA for overweight/obese patients classified as mild malnutrition (64%, p<0.001). The frequency of dismissal increased over the time: 29% (AprilJune), 34% (July-September) and 37% (October-December). Eleven providers were responsible for approximately a quarter of all BPA dismissals. There is lack of agreement between the RD and medical provider’s classification of malnutrition, specifically among overweight/obese patients. Further training is required to educate providers to educate providers to identify malnutrition.
Funding Disclosure: None
Funding Disclosure: None
Differences in Respiratory Muscle Strength in Well-nourished versus Malnourished Hospitalized Patients
Do Pre- and Postnatal Growth Failure Increase the Severity of Bronchopulmonary Dysplasia or Pulmonary Hypertension in Preterm Infants?
Author(s): H. Zellner, O. Moss, S. Hicks-McGarry, E. Moran, E. Becker, S. Peterson, S. Foley; Rush University Medical Center
Author(s): L. Lamport, I. Gershkovich, M. Ahmed, B. Weinberger, R. Schanler; Cohen Children’s Medical Center of New York, Northwell Health System
Learning Outcome: To determine the differences in measures of respiratory muscle strength between hospitalized patients who are malnourished vs. normally nourished.
Learning Outcome: Many studies have demonstrated that preterm infants with pulmonary hypertension (PH) and bronchopulmonary dysplasia (BPD) have higher nutrient requirements in order to achieve long term growth. No human study has investigated how pre- and post natal growth failure impacts severity of BPD and/or PH among premature infants. The learning objective was to determine if growth failure (pre & postnatal) is associated with BPD and or PH severity among VLBW infants.
Methods: A Dietary Supplement Use Questionnaire, sent to students via email, was designed by the investigators to determine the demographics, prevalence, and motivation of dietary supplement use. The Chi-square test was used to analyze differences in prevalence of dietary supplement use based on gender, ethnicity, and motivation for use. Results: A total of 372 completed surveys were returned; eight were excluded due to incomplete data. Survey respondents were more likely to be Caucasian females between the ages of 19 and 21 years of age (n¼ 198, 54%), with a high school degree (n¼ 258, 71%). Almost two-thirds (62%) reported using dietary supplements. Multivitamins were the most commonly reported dietary supplement and increased energy was the most common benefit identified. Most respondents reported using only one dietary supplement regularly (43.7%) at a frequency of six to seven times per week (52.1%). There were no significant differences in dietary supplement use and motivation for use between males and females or between Caucasians and African Americans.
Objective measurement of muscle mass is an essential component of nutritional assessment. Subjective global assessment (SGA) and handgrip strength (HGS) are tools used to assess nutritional status and musculature; however both have limitations. Depletion of muscle mass can manifest in loss of respiratory muscle strength (RMS). The purpose of this study was to determine differences in RMS measures (maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP)) in normally nourished vs. malnourished hospitalized patients using a crosssectional design. Nutritional status was assessed using SGA by a dietitian and MIP, MEP, and SNIP measures were obtained by a respiratory therapist. Independent t-tests were used to determine differences in RMS measures between subjects assessed as normally vs. malnourished per SGA. Of 140 patients who completed testing, 50% were normally nourished and 50% malnourished with mean age of 51.1 17.4 vs. 57.8 16.9 years, respectively (p ¼ 0.023). There was no significant difference in MIP between normally nourished (88.4 36.5%) and malnourished (77.6 36.0%, p¼0.093) subjects, and no significant difference in MEP (62.1 22.1 vs. 57.1 25.6%, p¼0.234). Malnourished patients had significantly lower values of SNIP (63.3 30.7%) compared to normally nourished patients (77.8 27.0%, p¼0.004). Use of RMS measures specifically SNIP, should be further investigated to assess nutriture and holds promise as a proxy measure of musculature. RMS measures may contribute to the arsenal of nutritional assessment measures used by dietitians. Funding Disclosure: Academy of Nutrition and Dietetics Foundation Grant, Dietitians in Nutrition Support Dietetics Practice Group
Background: Intrauterine growth restriction (IUGR) and postnatal growth failure (PNGF) are common in premature infants. Bronchopulmonary dysplasia (BPD) is chronic lung disease of prematurity, which can be associated with pulmonary hypertension (PH). The objective was to determine whether IUGR and PNGF increase the severity of BPD and PH. Methods: Infants with birth weight <1500 g and need for supplemental oxygen at 1 mo were enrolled prospectively (n¼68). Anthropometric measures were recorded at birth, 1 mo and 36 wks postmenstrual age (PMA), z-scores determined based on Fenton curves. PNGF was defined as weight < 10th percentile or z-score < -1.3. At 36 wks PMA, BPD severity was determined by NICHD criteria, and PH was quantified by echocardiography. Results: IUGR was present in 5 infants (7%), and PNGF in 17 (25%) at 1 mo and 24 (37%) at 36 wks PMA. There were no significant correlations between z-scores for weight, or intrapatient changes in z-score over time, and the severity of BPD or PH. Similarly, IUGR, PNGF, and nutrition were not predictive of BPD or PH. Mean daily intakes were 110.3 and 132.0 kcal/kg, and 3.9 and 4.2 g/kg protein at 1 month and 36 wks PMA. Of note, within-patient changes in growth z-score from 1 month to 36 wks were negatively correlated with changes in caloric intake, indicating that infants with the largest weight losses received the largest increases in calories.
Conclusion: The incidence of PNGF increases between 1 mo and 36 wks PMA in premature infants, but pre- and postnatal growth are not predictive for the severity of BPD or PH. PNGF increased despite achieving optimal targets for energy and protein intake. It is possible that the potential adverse effects of PNGF on pulmonary function are masked by improved nutrition. Funding Disclosure: Cohen Children’s Medical Center of New York, Northwell Health
A-22
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
September 2017 Suppl 1—Abstracts Volume 117 Number 9